B1 - Emergency Medical Stroke Assessment

Emergency Medical Stroke Assessment

Video

Let's take a closer look at what are the most important steps when conducting a Emergency Medical Stroke Assessment.

Remember to take notes. For better quality of the recording turn off the music in the background.

“The human capacity to fight back will always astonish doctors and philosophers. It seems, indeed, that there are no circumstances so bad and no obstacles so big that man cannot conquer them.” /Jean Tetreau/

DID YOU KNOW?

Around 66% of the time, it is the patient's family member, friend, or the person around them during a stroke who recognizes the warning signs of a stroke and decides to seek immediate medical care.

DID YOU KNOW?

Men and women show different stroke symptoms. Research states that 33% of women do not report typical or expected stroke symptoms like jaw or arm pain or drooping of the face. For this reason, stroke is more fatal in women. Women report less apparent symptoms like headaches that may not warrant emergency treatment.

DID YOU KNOW?

When an individual has a stroke, around 120 million brain cells die every hour. Compared to the regular rate of cell loss, the brain ages 3.6 years in that one hour without prompt treatment. So, the sooner the individual gets medical care, the better the chances of recovery.

DID YOU KNOW?

One can have multiple, less severe, or minor strokes that may cause no vague signs or symptoms. Some people may have dozens before they are diagnosed with a stroke. Though these strokes may seem insignificant, each can cause brain damage leading to memory loss, slurred speech occasionally, or difficulty thinking.

VOCABULARY

comprehensive

tissue plasminogen activator

endovascular

assessment

dissolve

capability

expertise

provider

clot

accurate

designed

onset

large vessel occlusion

brief

superior

occlusion

catheter

suitable

evaluate

particular

palms up

gaze

stroke

degree

slurred

stabilise

caused by

extreme

aphesia

abnormal

subtle

garbled

drift down

gem

straight out

incomprehensible

Your idiom for today

put someone of their stroke/stride

Your idiom for today

at the stroke of a pen

Your idiom for today

on/at the stroke of something

Your noun for today

a stroke of luck, genius, etc.

Your proverb for today

different strokes for different folks

Let's check what you remember

TRUE OR FALSE

Large vessel occlusion can be treated with catheter therapy in any hospital.

TRUE OR FALSE

Slurred speach can be a sign that a person has had a stroke.

TRUE OR FALSE

TPA works by extracting clots mechanically.

QUESTION TIME

What does EMSA stand for and what is it designed to do?

QUESTION TIME

Why is it fundamental to identify patients who might need catheter based endovascular therapy?

QUESTION TIME

Is it the blocked or the broken vessel that causes more strokes?

QUESTION TIME

Which therapies help with blocked vessels?

QUESTION TIME

What does TPA stand for? How does it work?

QUESTION TIME

How does catheter-based therapy work? Is it superior or inferior to TPA therapy?

QUESTION TIME

What tests are run during EMSA?

QUESTION TIME

What sign of stroke do we look for during eye movement test?

QUESTION TIME

How do we test motor strengths? What are the signs of stroke to look out for during this test?

QUESTION TIME

How do we test speech and language? What are the signs of abnormality?

FAST

F = Face drooping: Ask the person to smile. Does one side droop? A = Arm weakness: Ask the person to raise both arms. Does one arm drift downward? S = Speech difficulty: Ask the person to repeat a simple sentence. Are the words slurred? T = Time to call 9-1-1: If the person shows any of these signs, call 9-1-1 immediately. Stroke treatment can begin in the ambulance.

“Be willing to be a beginner every single morning.” /Meister Eckhart/

Thank you!

EMSA runs through:1. Testing eye movements - can a patient follow a pen, is the patient following a pen better in one direction than the other? 2. Testing motor strenghts - asymmetric face, arms or legs weakness 3. Slurred speech or aphasia - naming and repetition

oceniaćwpatrywanie, intensywne spojrzenie ustabilizować ekstremalny subtelny wyprostowany dłonie w górę stopień niewyraźny afazja (ograniczenie lub utrata zdolności mówienia lub rozumienia mowy) zniekształcony niezrozumiały szczególny udar spowodowany przez nienormalny znoszenie, dryf, dryft (z prądem) klejnot

evaluategaze stabilize extreme subtle straight out palms up degree slurred aphasia garbled incomprehensible particular stroke caused by abnormal drift down gem

We are looking for abnormal gaze while testing eye movement. The abnormal gaze can be extreme or very subtle. When a patient is not able to follow a pencil as well in one direction compared to the other, it is abnormal gaze.

Blocked vessel causes 80% of strokes, and 20% of strokes are caused by a broken vessel.

EMSA stands for Emergency Medical Stroke Assessment, and it was designed to help health care providers to identify stroke patients more accurately. Particularly, it is designed to identify patients with large vessel occlusion.It is designed to be brief, suitable for emergency situations and to have better accuracy compared to other pre-hospital stroke assessments.

TPA stands for tissue plasminogen activator. It works by dissolving the clot, and it must be used within the four and a half hours of stroke onset.

comprehensiveassessment provider accurate large vessel occlusion catheter endovascular capability expertise designed brief suitable tissue plasminogen activator dissolve clot onset superior occlusion

kompleksowy/wszechstronnyocena dostawca dokładny niedrożność dużych naczyń cewnik wewnątrznaczyniowy zdolność wiedza lub umiejętność specjalistyczna przeznaczony/zaprojektowany krótki, krótkotrwały odpowiedni tkankowy aktywator plazminogenu rozpuszczać skrzep początek lepszy niedrożność, okluzja

It's important to identify patients with large vessel occlusion who might need catheter based endovascular therapy because not all hospitals have the capability to treat these patients. They need to be taken to a comprehensive stroke centre or to a level one stroke hospital where the personnel has expertise to provide this kind of therapy.

There are two proven therapies in the case of blocked vessel - TPA and catheter based therapy.

In catheter-based therapy the clot is removed mechanically. The therapy works within six hours of stroke onset. Catheter based therapy was proven to be superior to TPA alone in patients with large vessel occlusion.

Motor strengths test looks for asymmetry.First, we test for facial weakness by asking a patient to smile, and show their teeth. If one side of the face droops, it is a sign of asymmetry. Secondly, we test arm strength by asking a patient to hold their hands straight out in front of them, palms up. We count slowly to ten, and observe for asymmetry - are the arms held up straight or is one clearly lowering? Only a clear different between the arms counts as abnormal. Thirdly, we test leg strength. Each leg is tested separately by holding the leg up, thirty degrees for five seconds. If one leg drifts down compared to the other, the asymmetry test is positive.

First, we check if a patient can name objects. We ask them to name two objects e.g., a pen and a watch. We also ask a patient to repeat a sentence e.g., "They heard him speak on the radio last night. “We look for slurred speech or aphasia. We listen for garbled, incomprehensible words and observe whether a patient is able to speak or not.